Methadone/LAAM Regulations

[Frankinscense]

Dr. Steve,
Opiate addiction is a disease and needs to be treated accordingly. Opiate addiction is a disease much like diabetes. A person takes insulin to maintain proper levels of sugar in their bodies. A heart patient takes digoxin to maintain proper heart functioning. An opiate addict may take LAAM or methadone to restore an imbalance in their brains due to the disease of opiate addiction.
                                                                  New regulations would allow personal physicians to treat opiate addiction in the privacy of their office. This would allow methadone patients adequate medical treatment and have the same degree of personal care that a diabetic or heart patient maintains. This would allow the opiate addict/patient to get their medicine from a physician intead of a pusher or dealer. This would stop a large majority of street crime and violence and stop the spread of aids and hep c.
                                                                  The average person or general public tends to think that all opiate addicts should be incarcerated due their addiction. The fact is society would be better off by allowing the opiate patient the treatment they need through their personal physicians. After all the opiate patient is suffering from a disease no different than a heart patient or a diabetic. So the medical profession and politicians should allow these new regulations to happen just as quickly as humanly possible!
Sincerely,
Dan...

[The Dude]

Dan I totally agree with you, but I don't think it'll ever happen.  You'd think they would legalize marijuana and tax it?  But no, they can't do that.  Drugs are the devil and as far as they're concerned, as long as they get their 3000$ a week paycheck, things will never change.  Wouldn't it be better if politicians worked on commision?  Everything they did good for humanity, the paycheck would be better.  Nope.  You are a very intelligent man, maybe we can all join forces and try and get petitions organized through a website?  Whatta ya think?  I designed websites, http://www.lachoza.tv maybe we should really do that.  If enough people raise hell may be something would be done.  Maybe I'm dreaming? Who knows, I'm tired of all of the **** you have to go through to get treated, just to be shunned.
Take Care
Chad

[tom to doc dan PLEASE READ]

Dan, my good friend, allow me to reprint a rather important extract of the regulations to which you refer. It was easy to miss, almost as if they were hiding it in the doc: Damn PDF, couldn't just cut and paste, so, lousy typer that I am (weird fact, many professional writers are lousy typists), I have keyed in the first part of the left column on page 2 of the Federal Register FINAL RULING, featured on the Lindsmith Center site:

Behold, and I quote:

"DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Service Administration

42 CFR Part 8
21 CFR part 291
[docket no. 98N-0617]

Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction

Agnecy: SAMHSA
Action: Final Rule(!)

Summary: The Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration (SAMHSA) are issuing final regulations for the use of narcotic drugs in maintenance and detoxification treatment of opioid addiction. This final rule repeals the existing narcotic treatment regulations enforced by the Food and Drug Administration (FDA), and creates a new regulatory system based on an accreditation model. In addition, this final rule shifts administration responsibility and oversight from the FDA to SAMHSA. This rulemaking initiative follows a study by the Institute of medicine (IOM) and reflects recommendations by the IOM and several other entities to improve opioid addiction treatment by allowing for increased medical judgment in treatment.
Dates: This final rule will be effective on March 19, 2001."

March 19th, 2001!

Please tell me this is what we've been waiting for! What could be more certain than:
"Dates: This final rule will be effective on March 19, 2001. [page two, first column, take a look]

To all other interested parties:

I have the PDF-format copy of this Federal ruling and will send it to anyone who gives me they're e-mail address. You can leave that address in privacy at my alias hotmail account,
***@****
if you prefer.

This, my friends, is unadulterated good news!

This legislation is restricted to opiate agonists such as methadone and LAAM, so, unfortunately, buprenorphine, being a mixed agonist/antagonist substance is not addressed by this legislation.

I believe this is the start of something big and will lead to the greater availability of methadone and LAAM for those of us suffering from this life-destroying disease.

Dan,

I'm not trying to upstage you on this, but you mentioned your work load and that you haven't had time to fully evaluate the ruling, so I thought I'd save you the trouble.  Let me know what you think, brother. Is this IT????

I was in such a spiritual hole and this news uplifts me and raises my spirits. Please tell me this is THE ONE.

your friend,
Dan
  

[cindi]

To Dan,   I have a question regarding the Physician being allowed to treat the patient privately with Methadone.  My question is will they?  I am a recovering addict but also a severe chronic pain person from several job related injuries to my back while working as a nurse.  I have found that not many docs in this area are willing to prescribe Vicodin.  These Docs are totally afraid of the DEA.  Seems someone is always being investigated.  What will make them unafraid to prescribe the Methadone?  Cindi

[tom to stubbornly silent Doc Dan on the]

I love you, brother, but you're trying my nerves. I'm looking at what seems to be momentous changes to the agonist therapy outlook for all of us and I can't get you to comment. I'm not asking for the Gettysburg address, just give me some feedback. Is it real? Is it reason to celebrate? What? I can't get the infomred perspetive I want from anyone on this forum but you. So all right already! Talk to me! I gave you the primary synopsis to comment on. I'm not looking for your Phd thesis here. What do you think? Say something, man. I'm in suspense here ... well, I guess you'll hold forth when you're ready. You just enjoy driving me nuts. Some kind of a new sport or something ... Oh well, I'll let you off the hook tongight. Be cool. Be spritual. Be serene. I'm sure when it comes, it will be a considered analysis worth archiving. But I wish you'd just do it ....  peace to you, Dan, my (reading) friend

[Dan to Tom]

Allow me to read it brother. ***@****
Dan..

[Brighty to Tom]

What do you think it means to "allow increased medical judgement" in opiate addiction treatment ?? I am not being negative... I honestly don't know how to interpret their weasel wording. FWIW, my husband's aunt Dottie has been getting methadone for a couple of years from an MD for neuropathy in her feet... chronic pain. Can't they write it that way for an addict if they so choose ?? This is all hard for me to understand. Thanks for your thoughts. Love, Brighty

[tom to Brighty]

If one, oh, picking someone at random, say, a raving narcotics addict named, say, "tom" were to find a cool enough doctor who would use tom's very real back MRI's as an excuse to prescribe methadone, than tom could already be on methadone maintenance. The doc would simply have to write on the scripts "prn for pain," rather than "prn for opiate addiction therapy." A little bit of ink on a triplicate rx, and I could be on methadone right now. The fact is, with three bad disks and one surgery in my history, the case for dispensing methadone to me could be made rather easily. But I've never known, or was aware I knew, a doctor who would be willing to finesse the issue in my favor, so I've never asked. I bet it goes on every day.

I think "increased medical judgment" is a way of saying "having a larger pool of doctors" authorized to treat opiate addiction, thereby making agonist-based therapy accessible to more addicts.

One caveat: the regs, while taking certification away from the FDA and DEA and putting it in the hands of SAMHSA, which, I pray, can be expected to be a little more liberal in certifying doctors to treat opiate addiction, it sounds as if the applying doctor still must be "affiliated" in some way with an established OTP, or Opiate Treatment Center. "Affiliated" may simply mean the doc has to maintain some relationship with an OTP but can still practice in his own office. I certainly hope this is what it means.

Brighty, since you clearly possess the intelligence to interpret this final ruling for the betterment of us all, I've sent you the whole PDF file containing the entire Federal Reg final ruling. The excerpt you read in Dan's message occurs at the very beginning of the document. There's quite a lot of qualifying detail to get through. Perhaps you can get a little more out of it than I have. I've sent it to your "healing light" address. Hope they tolerate large attachments. Good reading. By the way, my e-mail will obviously tell you who I am and I trust you not to disseminate that address to anyone. You may use it to reach me directly from now on.
If others must contact me privately, I maintain a "***@****" account. But with you, Brighty, I find myself wanting a more direct communication. Doc Dan now has it as well. Not that it's any great honor to know my name, but for what it's worth. Here I am.

[tom to Brighty]

my mail to your healing light address was returned as a bad address. Could you give it to me again?

[Brighty to Tom]

Tom.. .my address is ***@**** and I did get something from you but I have not downloaded it yet. If it does not download or open correctly I will reply. Give me some time for this please... your identity LOL.... do you think my name is really Bright Light ??? No need to have any concern... I am on an ibogaine list at another e-mail box. I am a nice middle aged lady who is probably on some CIA dangerous person list right now.. and I don't care. I plan to take my daughter out of the country to have an ibogaine treatment when she is off probation. Love, Brighty

[tom to Brighty]

all you'll need is Adobe's Acrobat pdf reader, which I think you've already got as part of the bundled files you get with your Yahoo account. In any event, it's easy to download and install. I wouldn't worry about not being able to read it. I'm just anxious to hear some more opinions about these changes. I think giving certification rights to SAMHSA and not the FDA/DEA is huge! It will mean a lot of doctors will be able to treat addiction as the disease it is.
Please give my best to your dear daughter and good luck with the ibogaine. I must say to you, Brighty, that you are anything but "just" a middle aged woman with an addicted daughter. You short-shrift yourself and ignore the incredible commitment you've made to this situation we all find ourselves in. I can't tell you how many times your words have comforted me and helped me keep going. Call me a dreamer, but I see a Presidential Medal of Freedom in your future.

[Frankinscense]

It will not be as simple as writing prn for addiction. Regulation of doses will be a major problem for doctors. I suspect most doctors will not want the hassels anyways of the detective work required to police addicts. A physician simply cannot give an addict a pint of methadone to take home with them to treat their addiction. It simply will not work that way for obvious reasons. It will still require doctors to fill out a ton of paperwork that many I suspect will object to. So don't look for any major changes on doctors attitudes regarding addicts even if these requlations to occur as it looks like they may.
Dan..

[Brighty to Tom----oops!!]

I replied to you but I goofed and posted it under the thread titled "methadone and darvon"... but I did not open your document yet... will do so soon. Love, Brighty

[tom to Dan]

you know how doctors are always looking for new services to charge for? I'm thinking they'll employ all the psychologists that can't get patients now because the HMOs won't pay for more than 3 sessions of therapy, and make them into a sort of recovery case worker who COULD follow individual patients, counseling them when they came in for their daily or weekly methadone. I never thought for a moment that anyone was going to get 1-month "jug" of methadone. (Gives the old folk song "lil brown jug" a radically different meaning, doesn't it?)

Let's you and I give the collective minds of all these professionals some time to think, study European models, etc. and see what they come up with, Dan, my counseling man. Who knows what we can come up with given a little lee way?

Positive thoughts, man. No pessimisms today, huh? Did you read my hijacked post on Jim's thread? Walk away from one job in disgrace, discover the same thing happened to my predecessor, and now it looks likes I'll be working for him in a few weeks for more money and stock options - go figure. It's the luck of the irish, I'm sure of it!!!

My big question I'm facing for real right now --- I may have a week off of work starting right now. I think I'll go to the methadone clinics tomorrow and see what I can see. I might get onto the UCLA buprenex detox program or, who knows, I might go MMT like you.

Big things could be happening, my friend. And I guarantee you'll catch your share of credit if I have anything to say about. Say, I wish we could meet sometime in the flesh. Where did you say you worked?

[Dan to Tom]

Lost a long letter to you a few minutes ago. Due to my lack of time I will have to type it @ another time. Your Friend!
Dan...

[Dee]

Your a good talker, and you seem to be very educated in the area of detoxing, you can recite alot of laws on the books,you also have been 'talking' talking talking about being able to detox at home with your own doctor,Iam wondering,IF and WHEN this all becomes legal,if the chance actually does become reality,if you will really step up onto the plate and do it..drug addicts love to talk,but rarely do they follow through..(there are some on here who meant it and did it)I can't help but wonder if all your 'talk' about getting clean is just that, 'talk' and deep down you know that it will be a very long time before any laws are changed..so your safe to continue your drug use without having to stop any time soon..just a thought....

[tom to Tom]

I'm sorry if I offended you by participating in the forum. Perhaps I should retire from leaving posts. I can tell you that I also wonder if I can follow through with all this when it becomes legal. I disagree with your pessimistic time frame. Some of this SAMHSA legislation takes effect in a matter of a few months.

What bothers me about your post is the obvious hostility you seem to feel toward me. Since you never left your name, I cannot know if there is or was some dialogue between us that makes you say the things you say in the way you say them.

I am an addict struggling like all addicts and I reach out with whatever I have to offer because I feel so very alone in my disease. I do not consider myself to be special or worthy of a "following." I am not a role model and have never tried to be.

Some on this forum have my private address and I will always be ready to listen should they need me for anything.

I don't know if it's the way you said what you said , or the timing, but you have really brought me down and made me regret my presence here. I'll say this to you now. I will not post to this forum until I follow through with one of the treatment options.

The forum's all yours now. One suggestion, stop posting anonymously and start standing behind your own words. The way you chose to address me was cowardly and callous and I can only hope that, now that you're in charge of the forum, you'll show some conviction for your opinions and allow people to identify you so that they may renounce you as you have renounced me.

[tom with a post script to TO Tom]

you know, my nameless "fellow Poster" [what the hell do I call you?], I reviewed your comments and I must tell you that, upon reflection, I could easily imagine myself saying the very same things and asking the very same questions of a poster that, month after month, sifted through the minutia of regulations and proposals and drug combinations, etc., etc., etc., while never settling on a plan of action or carrying one out.
You're right about me in many ways: I am afraid to actually "cut the cord" and submit to treatment. Over the course of thirty or so years, I've been one of those disheveled, unshaven guys in the bathrobe shuffling through one treatment program or another, lining up at nurses' stations for daily cups of pills. I've also been one of those lucky fellows in the orange jumpsuits peering through the cage at a judge, anxiously trying to locate my public defender, waving my handcuffs to attract my wife and silently mouthing the words, "Did you MAKE BAIL?"
I've lived in residential recovery homes doing the 90 meetings in 90 days thing while under electronic house arrest. You name the wall, I've bounced off of it.
However, in my own defense, let me suggest to you that much of what you read in my posts of late is my attempt to do something I've never really done before: Get smart about my recovery and think before I commit myself to a course of action. I want this one to be THE one that works. And there are new things in the mix that alter the equation and call for consideration before being accepted or rejected.
Buprenorphine, for example. I remember reading about bup in the magazine Omni several DECADES ago! It's taken this long for this apparent wonder drug to finally surface in a form capable of helping addicts like me. And yet, the closest I've gotten to buprenorphine in California was the promise of a doctor to put me on a waiting list to participate in a double-blind placebo study at UCLA!
I want to make the intelligent choice, and, yes, I admit, I've had my fill of "centers" and "programs" and damnit-all, I  want to go to a private doctor and be treated in a private setting - if at all possible. I've recently spoken to doctors claiming to be addiction specialists who have not even heard of buprenorphine!
If you're an opiate addict in California who for professional reasons really needs to keep your disease and treatment confidential, try this one: find 10 MD's in any given directory - on or offline - who claim to be addiction specialists. Tell them your problem, your history, your situation, and then ask them what they recommend you do - Be prepared for 10 completely different, often contradictory, and, more often than not, self-serving answers.
If it makes you feel any better, it's been years since I've actually "gotten high" from my drugs. They stave off withdrawal, and help me get to work in the morning and bring home a paycheck. That's about all. I do want to make a change, but I want it to be the one that finally works for me. Meanwhile, it's a free-for-all out there in the drug treatment world. The more I learn about the state of things here in California, the less I know about what I should do to help myself.

[Dee]

well, your second post was certainly more 'level headed' than the first, when your first reaction was to 'jump' at me..and be very defensive,which I'm sure is a very normal first reaction..
your sentence,'you have really brought me down and made me regret my presence here'only show's your scared to face some things head on..it is not the first time that you have not liked someone's opionion or thought and tried to run from it..saying 'I will not come back' my post was by no means meant to 'hurt' you maybe just to challenge you some..to get underneath all the hard facts of M/L regulations, and laws,it was to get to the core of who and what 'Tom' is underneath and where exactly does he stand for real..you say the way I addressed you was 'cowardly' and callous..maybe so, I have seen what happens when one does not agree with what one has to say, and have watched them be attacked for stating their thoughts,
so,to be called a coward, I accept..many here on this forum enjoy reading your post's as do I..and do not want you to 'run away'that will be a choice that you make..enjoy the day..

[tom to coward]

I suggest the only one doing any running is you, because you still refuse to give yourself a handle. What are YOU afraid of? It's not as if anyone's asking for your social security number.

As you've pointed out, I've often contemplated leaving the forum. Why do I say these things only to return again and again? Because I bare my soul, or at least try to, to the members of this forum. If that's what I am feeling and thinking at that moment, I post it and signed my name to it so that lurkers such as you can dissect me in safety. I'm not afraid to have my weaknesses and hypocrisies pointed out to me. In fact, it's one of the reasons I return again and again and again.

I challenge you to bare your soul to us. Tell us your story. How much pain have you caused yourself and others over the years? How many lies have you told to get what you wanted? What life-altering decisions would you go back and change if you could? I'd love to know these things about you because your posts tell me that you're intelligent, articulate, incisive and philosophical. But they have no value on this forum if you don't leave a name.

I'd hate to see you wind up with the handle "coward" by default. I'd much rather call you by a name of your own choosing.

[coward please choose a handle and respon]

you're keeping the thread waiting. rude in most parts of the world. Don't let silence be your epitaph. Choose a name, make a statement. participate in the world, don't just squat on the earth as it spins around through space, a meaningless ornament and a plain one at that.

[From Aunt Lindy to Mariah]

that is all.

[To TOM RE: Dan]

......I have been wondering what happend to Dan also.  I sorta took the "hard-line" w/ Dan in my last post to him.  When I'm finished here.....I will go back through the thread and re-read my post.  I believe it was addresse to: "doc" Dan and Dear Tom.
I hope it wasnt anything I said to deter him from posting here.
I just feel He takes such a tuff stance on the issues of chronic sufferers and pain meds, and understandably so.
Annie

[PS >>>>Annie]

Oh well, looked over and over for My "doc" Dan and Dear Tom post.
Guess it disappeared into infinity.

[Thomas02]

I guess we'll never know ... I've never understood lurkers with such strong points of view but no stomach for a true debate. Ah, well ... and so it goes.

[PS >>>>Annie]

Do you recall what Dan said in his last post??  He was in a lot of pain.  I guess he could be in a battle w/ his own pain demons right now.  Perhaps, he was trying to convince himself of what he was espousing ....the whole time.  I do have to say, Its got to be hard to battle pain and addiction at the same time....Whats a person to do.  Will be on the look out.

[spook]

Of all the Opioid drugs on this planet the very hardest one to get off is METHADONE,if anybody thinks that this will help their Opioid dependency then you will have to learn the hard way by trying it.
Withdrawals peek on day 10 subside to a almost tolerable level over next 3 weeks and gradually dissapear usually not within 5 months.
Followed by a protracted withdrawal syndrome lasting around 1 year.
Compare to Morphine:peek 24-72 hrs,dissapear within 14 days and protracted at most 6 months.
YOU HAVE BEEN WARNED!

[PS >>>>Annie]

Have you also noticed where he is posting most of the time.  Seems to know a lot about us.......Ya know, for being new to this forum.  He spent an awful lot of time here today, ya know, for being a new comer and all.  lol

[Thomas02]

I guess he decided "coward" wasn't such an attractive handle after all. His academic knowledge about the opiates is always interesting, but you only have to wait a few sentences for the self-righteous **** to set in. My guess is, if you had him as your councilor at a methadone clinic, you'd find him long on pharmacological info and short as hell on human insight and empathy. I think he takes the puritan's view that addicts deserve every minute of their suffering and then some. In an age when people are finally starting to treat addiction as a medical condition, he seems to cling to the idea that people become addicted because they are morally defective and undeserving in the eyes of god. That's an old saw I'd hoped we'd put to rest. He seems intent on resurrecting it. He doesn't strike me as being the least empathetic with the posters he interacts with on this forum. His dispensing of pharmacological info is just a hook to draw you in before he lets you know how worthless he thinks you are as a human being. Personally, I've heard quite enough of it.

[Gina]

Well I guess its not Dan since he is AGAINST methadone. Now that I am officially sick to my stomache from reading his message about methadone(How horrible it is to get off) my day is ruined. Although its going very well (MMT) for me at present, everyone knows my greatest fear has been when its time to start tapering. I am already getting pressure from my spouse. I do know that at my clinic they will cut down by 3mgs. if necessary to keep you comfortable. I need to hear something positive about MMT. Anybody???????

[PS >>>>Annie]

I think your right.  His name does suit him well.  One moment he seems somewhat affable, and the next somewhat facetious.  He does seem to be knowledgable, but socially inept.  I sense that he falls somewhere around the "new age" way of thinking.  I may be wrong.  His post are very perplexing.